A nurse delegates the task of intake and output to a new nursing assistant. The nurse knows that the assistant understands the task when the assistant states:

A. "I'll record the amount of urine."
B. "I'll disregard liquid stool as output."
C. "I won't include ice cream or sherbet as oral input."
D. "I'll note perspiration and record as small or large amount."


A
Intake includes all liquids taken by mouth, through nasogastric or jejunostomy feeding tubes, IV fluids, blood and blood components. Output includes urine, diarrhea, vomitus, gastric suction, and drainage from surgical wounds or other tubes.

Nursing

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One strategy for empowering nursing is to employ the media to create a more powerful image of nursing. This can be done by:

a. Having more nurses play leading roles b. Writing more books about nursing history c. Having TV spots promoting a positive nursing image d. Showcasing the work of hospitals

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A trauma patient was admitted to the ICU with a brain injury. The patient had a change in level of consciousness, along with a change in vital signs, and became diaphoretic and agitated. The nurse would know that the patient is having what?

A) An adrenal storm B) A hypothalamic storm C) A sympathetic storm D) A parasympathetic storm

Nursing

A male patient tells the nurse that he has "excruciating pain" in his perineal region that started a few days after having an indwelling urinary catheter removed

Upon inspection, the nurse sees a dime-sized reddened area on the patient's perineum below the scrotal sac. Which of the following should the nurse do to help this patient? 1. apply a warm compress to the region 2. apply ice to the region 3. obtain an order for a pain medication 4. have the wound further evaluated for possible Fournier's gangrene

Nursing

In order to prevent the possibility of venous stasis, a nurse is teaching a surgical client how to perform leg exercises. Which of the client's following statements indicates a sound understanding of leg exercises?

A) "I'll practice these now and try to start them as soon as I can after my surgery." B) "I'll try to do these lying on my stomach so that I can bend my knees more fully." C) "I'll make sure to do these, as long as my doctor doesn't tell me to stay on bed rest after my operation." D) "I'm pretty sure my stomach muscles are strong enough to lift both of my legs off the bed at the same time."

Nursing